Skip to main content
Log in

Functional disability in nonspecific low back pain: The role of pain-related fear and problem-solving skills

  • Published:
International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Previous studies have shown that pain disability in chronic back pain patients is closely associated with pain-related fear and avoidance. This study was aimed at replicating this finding in a sample of low back pain (LBP) patients with a new episode of sick leave. In addition, the supplemental value of problem solving in predicting pain disability was examined. It was further hypothesized that problem solving would moderate the effects of daily stress on pain disability. The results were partly as predicted. Pain-related fear, pain intensity, pain catastrophizing, daily stress, and problem solving were found to be individually related to functional disability, of which pain intensity and pain catastrophizing were the strongest predictors. Problem solving neither added predictive value regarding pain disability, nor could the moderating role of problem solving be confirmed. Surprisingly, and in disagreement with previous findings, pain intensity was found to be closely related to disability in this sample of LBP patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Aldrich, S., Eccleston, C., & Crombez, G. (2000). Worrying about chronic pain: Vigilance to threat and misdirected problem solving.Behaviour Research and Therapy, 38, 457–470.

    Article  PubMed  Google Scholar 

  • Arrindell, W. A., & Ettema, J. H. M. (1986).SCL-90. Handleiding bij een multidimensionele psychopathologie indicator (SCL-90; Manual of a multidimensional psychopathology-indicator). Lisse, The Netherlands: Swets & Zeitlinger.

    Google Scholar 

  • Baron, R. M.,& Kenny,D.A. (1986). The moderator-mediator variable distinctioninsocial psychological research: Conceptual, strategic, and statistical considerations.Journal of Personality and Social Psychology, 51, 1173–1182.

    Article  PubMed  Google Scholar 

  • Bergner, M., Bobbitt, R. A., Carter, W. B., & Gilson, B. S. (1981). The Sickness Impact Profile: Development and final revision of a health status measure.Medical Care, 19, 787–805.

    Article  PubMed  Google Scholar 

  • Burton, A. K., Tillotson, K. M., Main, C. J., & Hollis, S. (1995). Psychosocial predictors of outcome in acute and subchronic low back trouble.Spine, 20, 722–8.

    Article  PubMed  Google Scholar 

  • Crombez, G., Vervaet, L., Lysens, R., Baeyens, F., & Eelen, P. (1998). Avoidance and confrontation of painful, back-straining movements in chronic back pain patients.Behavior Modification, 22, 62–77.

    Article  PubMed  Google Scholar 

  • Crombez, G., & Vlaeyen, J. W. S. (1996).The Pain Catastrophizing Scale. Unpublished authorized Dutch/Flemish translation.

  • Crombez, G., Vlaeyen, J. W., Heuts, P. H., & Lysens, R. (1999). Pain-related fearis more disabling than pain itself: Evidence on the role of pain-related fear in chronic back pain disability.Pain, 80, 329–339.

    Article  PubMed  Google Scholar 

  • D’Zurilla, T. J., Nezu, A. M., & Maydeu-Olivares, A. (1994).Manual for the Social Problem Solving Inventory-Revised. Unpublished manuscript, State University of New York at Stony Brook.

  • Fordyce, W. E. (1976).Behavioral methods for chronic pain and illness. St. Louis, MO: Mosby.

    Google Scholar 

  • Gatchel, R. J., & Turk, D. C. (1996).Psychological approaches to pain management. A practitioner’s handbook. New York, London: Guilford.

    Google Scholar 

  • Gommans, I., Koes, B. W.,& Van Tulder, M. W. (1996). Validity and responsivenessofthe Dutch adaption of the Roland Disability Questionnaire. In M. W. Tulder Van, B. W. Koes, & L. M. Bouter (Eds.),Low back pain in primary care: Effectiveness of diagnostic and therapeutic interventions (pp. 57–70). Amsterdam: EMGO Institute.

    Google Scholar 

  • Jensen, M. P., Turner, J. A., & Romano, J. M.(1991). Self-efficacy and outcome expectancies: relationship to chronic pain coping strategies and adjustment.Pain, 44, 263–269.

    Article  PubMed  Google Scholar 

  • Klenerman, L., Slade, P. D., Stanley, I. M., Pennie, B., Reilly, J. P., Atchison, L. E., Troup, J. D., & Rose, M.J. (1995). The prediction of chronicity in patients with an acute attack of low back pain in a general practice setting.Spine, 20, 478–484.

    Article  PubMed  Google Scholar 

  • Kopec, J. A., Esdaile, J. M., Abrahamowicz, M., Abenhaim, L., Wood Dauphinee, S., Lamping, D.L., & Williams, J. I. (1995). The Quebec Back Pain Disability Scale. Measurement properties.Spine, 20, 341–352.

    Article  PubMed  Google Scholar 

  • Kori, S. H., Miller, R. P., & Todd, D. D. (1990). Kinesiophobia: A new view of chronic pain behavior.Pain Management (Jan/Feb), 35–43.

  • Lethem, J., Slade, P. D., Troup, J. D.,& Bentley, G. (1983). OutlineofaFear-Avoidance Model of exaggerated pain perception-I.Behaviour Research and Therapy, 21, 401–408.

    Article  PubMed  Google Scholar 

  • Luteijn, F., Starren, J., & Van Dijk, H. (1985).Handleiding bij de Nederlandse Persoonlijkheids Vragenlijst (Manual of the Dutch Personality Questionnaire, revised). Lisse, The Netherlands: Swets & Zeitlinger.

    Google Scholar 

  • Nezu, A. M., Nezu, C. M., Friedman, S. H., Faddis, S., & Houts, P. S. (1998).A problem solving approach. Helping cancer patients to cope. Washington DC: American Psychological Association.

    Book  Google Scholar 

  • Nezu, A. M., & Ronan, G. F. (1988). Social problem solving as a moderator of stress-related depressive symptoms: A prospective analysis.Journal of Counseling Psychology, 35, 134–138.

    Article  Google Scholar 

  • Osman, A., Barrios, F. X., Kopper, B. A., Hauptmann, W., Jones, J., O’Neill. E.(1997). Factor structure, reliability, and validity of the Pain Catastrophizing Scale.Journal of Behavioral Medicine, 20, 589–605.

    Article  PubMed  Google Scholar 

  • Patrick, D. L., Deyo, R. A., Atlas, S. J., Singer, D. E., Chapin, A., & Keller, R. B. (1995). Assessing health-related quality of life in patients with sciatica.Spine, 20, 1899–1908.

    Article  PubMed  Google Scholar 

  • Philips, H. C. (1987). Avoidance behaviour and its role in sustaining chronic pain.Behaviour Research and Therapy, 25, 273–279.

    Article  PubMed  Google Scholar 

  • Roland, M.,& Morris, R. (1983). A studyof the natural history of back pain. Part I: Development of a reliable and sensitive measure of disability in low-back pain.Spine, 8, 141–144.

    Article  PubMed  Google Scholar 

  • Schoppink, L.E., van Tulder, M. W., Koes, B. W., Beurskens, S. A., & de Bie, R. A. (1996). Reliability and validityofthe Dutch adaptation of the Quebec Back Pain Disability Scale.Physical Therapy, 76, 268–275.

    PubMed  Google Scholar 

  • Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and validation.Psychological Assessment, 7, 524–532.

    Article  Google Scholar 

  • Van den Hout, J. H. C., Vlaeyen, J. W. S., Kole-Snijders, A. M. J., Heuts, P. H. T. G., Willen, J. E. H. L., & Sillen, W. J. T. (1998). Graded activity and problem solving therapy in sub-acute non-specific low back pain.Physiotherapy, 84, 167.

    Article  Google Scholar 

  • Van den Kloot, W. A., Oostendorp, R. A., van der Meij, J., & van den Heuvel, J. (1995). De Nederlandse versie van ‘McGill pain questionnaire’: een betrouwbare pijnvragenlijst [The Dutch Version of the McGill pain questionnaire: a reliable pain questionnaire].Nederlands Tijdschrift Voor Geneeskunde, 139, 669–673.

    PubMed  Google Scholar 

  • Vingerhoets, A. J. J. M., & Van Tilburg, M. A. L. (1994).Alledaagse Problemen Lijst, APL(Dutch manual of the everyday problem checklist, EPCL). Lisse, The Netherlands: Swets & Zeitlinger.

    Google Scholar 

  • Vlaeyen, J. W. S., DeJong, J., Geilen, M., Heuts, P. H. T. G., & Van Breukelen,G. (2001). Graded exposure in the treatment of pain-related fear: A replicated single case experimental design in four patients with chronic low back pain.Behaviour Research and Therapy, 39, 151–166.

    Article  PubMed  Google Scholar 

  • Vlaeyen, J. W., Kole Snijders, A. M., Boeren, R. G.,& van Eek, H. (1995). Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance.Pain, 62, 363–372.

    Article  PubMed  Google Scholar 

  • Waddell, G., Newton, M., Henderson, I., Somerville, D., & Main, C. J. (1993). A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability.Pain, 52, 157–168.

    Article  PubMed  Google Scholar 

  • Waddell, G., & Turk, D. C. (1992). Clinical assessment of low back pain. In D. C. Turk & R. Melzack (Eds.),Handbook of pain assessment (pp. 15–36). New York, London: Guilford.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Johanna H. C. van den Hout.

Additional information

This study was supported by Grant No. 940-31-004 of the Council for Medical and Health Research of the Netherlands (MW-NWO).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hout, J.H.C.v.d., Vlaeyen, J.W.S., Heuts, P.H.T.G. et al. Functional disability in nonspecific low back pain: The role of pain-related fear and problem-solving skills. Int. J. Behav. Med. 8, 134–148 (2001). https://doi.org/10.1207/S15327558IJBM0802_04

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1207/S15327558IJBM0802_04

Key words

Navigation